Thoracic Empyema in HIV-Infected Patients: Antimicrobial agents
The antimicrobial agents administered are listed in Table 4. Based on microbiological findings, antibiotics were changed in 83% (19/23) of the cases (by a more sensitive or less toxic agent). Pathogens resistant to ampicillin were isolated in 8 of 61 cases (13%). These included two S pneumoniae, three Haemophilus species, one Streptococcus intermedins, one Streptococcus viridans, and one Aeromo-nas hydrophila. Pathogens resistant to cloxacillin were identified in two cases (one S aureus and one Staphylococcus coagulase negative). Bacterial pathogens resistant to second- and third-generation cephalosporins and piperacillin were isolated in 7 of 61 cases (11%) and all of them involved aerobic Gram-negative bacilli (5 Pseudomonas aeruginosa and one Acinetobacter Iwolfii).
All the patients survived and were discharged from the hospital. Long-term follow-up was available in 18 patients for an average of 36±28 months (range, 4 to 84 months). Four patients died, with an average survival of 35 months (range, 4 to 84 months) and all had an AIDS diagnosis when they presented with the empyema. Of the remainder, eight fulfilled AIDS criteria (57%) after an average follow-up of 39±21 months (range, 10 to 84 months). buy asthma inhalers online
Bacterial infections are a well-documented complication in patients with HIV and AIDS diagnosis, but most of the clinical reviews are noted for their lack of empyema documentation. Bacterial pneumonia is a common source of morbidity and mortality among these patients. The annual incidence of pneumococcal pneumonia and other respiratory pathogens, such as H influenzae, are considerably higher when compared with the general population. There are few cases of clearly documented HIV-associated thoracic empyema, despite both increased incidence and severity of infections.
Table 4—Antibiotic Therapy and Sensitivity Studies
|Cephalosporins, 2nd-3rd generation||12||8|
|Resistance (10/20 patients)||No.|
|Cephalosporin, 2nd-3rd generation||6|